Prehabilitation: How Exercise

What Is Surgical Prehabilitation and Why Does It Matter?

Prehabilitation reframes the period between surgical decision and the operating room as an active treatment window rather than passive waiting time. The concept rests on a simple physiological principle: patients who enter surgery with greater cardiorespiratory fitness, better nutritional status, and stronger muscle mass tolerate the metabolic stress of an operation more effectively. Major surgery imposes a stress response comparable to running a marathon, and patients with limited reserve are more vulnerable to pneumonia, wound complications, delirium, and prolonged immobility.

The new review synthesizes evidence across surgical specialties — from colorectal and thoracic procedures to orthopedic and cardiac operations — and consistently finds that multimodal prehabilitation outperforms usual care. Programs typically combine aerobic and resistance training, protein-focused nutritional optimization, smoking cessation, and anxiety management. Even short interventions of two to four weeks appear to deliver measurable benefits, which matters because surgical timelines often do not allow longer preparation.

How Does Prehabilitation Reduce Complications and Hospital Stay?

The mechanisms are multifactorial. Aerobic conditioning improves oxygen delivery and the ability to mobilize early after surgery, which is one of the strongest predictors of avoiding pulmonary complications. Resistance training preserves lean muscle mass — important because immobility and surgical catabolism can erode muscle rapidly, delaying recovery. Nutritional optimization, particularly correcting protein deficits and micronutrient gaps, supports wound healing and immune function during the vulnerable postoperative window.

Across the studies reviewed, patients enrolled in structured prehabilitation programs experienced fewer postoperative complications and were discharged earlier than matched controls receiving standard preoperative care. Reduced length of stay carries downstream benefits: lower risk of hospital-acquired infections, less deconditioning, and substantial cost savings for health systems. The authors argue that prehabilitation should be considered a standard component of surgical care, not an optional add-on, particularly for older adults and patients with frailty or significant comorbidity.

Who Benefits Most and How Should Prehabilitation Be Implemented?

Patients with the lowest baseline fitness or the greatest nutritional risk tend to show the largest absolute gains, since they have the most physiological room to improve. This includes older adults, patients with sarcopenia, and those with chronic conditions such as COPD, heart failure, or diabetes. However, even fitter patients undergoing high-stress operations can benefit, as small improvements in reserve can translate into meaningful reductions in complication risk.

Practical implementation requires coordination between surgeons, anesthesiologists, physiotherapists, dietitians, and primary care. Home-based programs supported by digital tools and remote monitoring have made prehabilitation more scalable, removing barriers like travel and supervised gym access. Health systems integrating prehabilitation into elective surgical pathways report not only better clinical outcomes but also improved patient engagement, with many patients reporting that the structured preparation gave them a sense of agency before a stressful procedure.